ABSTRACT
Background: The biologic mechanisms underlying neurologic post-acute-sequelae of SARS-CoV-2 infection (PASC) are incompletely understood. We measured plasma markers of neuronal injury (glial fibrillary acidic protein [GFAP], neurofilament light chain [NfL]) and inflammation among a cohort of people with prior confirmed SARS-CoV-2 infection at early and late recovery following the initial illness (defined as < and > 90 days since COVID-19 onset, respectively). We hypothesized that those experiencing persistent neurologic symptoms would have elevations in these markers. Methods: The primary clinical outcome was the presence of self-reported central nervous system (CNS) PASC symptoms during the late recovery timepoint. We compared fold-changes in marker values between those with and without CNS PASC symptoms using linear mixed effects models and examined relationships between neurologic and immunologic markers using rank linear correlations. Results: Of 121 individuals, 52 reported CNS PASC symptoms. During early recovery, those who went on to report CNS PASC symptoms had elevations in GFAP (1.3-fold higher mean ratio, 95% CI 1.04-1.63, p=0.02), but not NfL (1.06-fold higher mean ratio, 95% CI 0.89-1.26, p=0.54). During late recovery, neither GFAP nor NfL levels were elevated among those with CNS PASC symptoms. Although absolute levels of NfL did not differ, those who reported CNS PASC symptoms demonstrated a stronger downward trend over time in comparison to those who did not report CNS PASC symptoms (p=0.041). Those who went on to report CNS PASC also exhibited elevations in IL-6 (48% higher during early recovery and 38% higher during late recovery), MCP-1 (19% higher during early recovery), and TNF-alpha (19% higher during early recovery and 13% higher during late recovery). GFAP and NfL correlated with levels of several immune markers during early recovery (MCP-1, IL-6, TNF-a, IFN-g);these correlations were attenuated during late recovery. Conclusion: Self-reported neurologic symptoms present approximately four months following SARS-CoV-2 infection are associated with elevations in markers of neurologic injury and inflammation at early recovery timepoints, suggesting that early injury can result in long-term disease. The correlation of GFAP and NfL with markers of systemic immune activation suggests one possible mechanism that might contribute to these symptoms. Additional work will be needed to better characterize these processes and to identify interventions to prevent or treat this condition.
ABSTRACT
Purpose The sudden pandemic of COVID-19 has caused disruptive innovation in all areas of business including education. Despite the educators' and students' acceptance and readiness in the new normal, the traditional face-to-face (FTF) public speaking has been shifted to online courses to suit the current needs. This study aims to examine whether there were differences between online and FTF pubic speaking in the students' anxiety level, speech performance, as well as their perceptions of the challenges in the implementation of online public speaking courses as a potential to disruptive innovation. Design/methodology/approach This pilot study was a mixed method research that involved a purposive sampling of two groups of 39 students in higher education. The instruments used were questionnaires of self-report anxiety, speech performance test and observation. Findings The findings show that the students preferred the traditional FTF rather than the online mode for public speaking courses. The challenges of internet connection and the lack of a live audience were their main concerns in online public speaking. It also provides a potential for disruptive innovation that could take into consideration of a live audience in university online courses. Originality/value This study provides the potential of public speaking course as a disruptive innovation. This brings implications for the innovators, marketers and educators to think of the online courses/programmes that can be best implemented while embracing the changes and the new normal of COVID-19 brings for student learning.